Abstract
Abstract BACKGROUND Stereotactic radiosurgery (SRS) in brain metastases is associated with prolonged quality of life, locoregional control, and stabilisation of neurological symptoms. Optimal patient selection is pivotal to achieving improved overall survival (OS). This study aimed to evaluate patient and disease factors associated with optimal outcomes. METHODS This retrospective study analysed 3,940 intracranial metastases in 1,113 patients treated with SRS at the Leeds Gamma Knife Centre between 2010 and 2020. Data on primary tumour, Karnofsky performance status (KPS), intracranial disease burden, steroid therapy, and treatment toxicity were recorded. Follow-up MRI imaging was performed at 6 months. OS curves were compared using the Log-Rank test (p < 0.05). RESULTS Multivariate analysis revealed primary diagnosis (p < 0.001), KPS (p < 0.001), number of lesions (p = 0.005) and total tumour volume (p = 0.012) as significant predictors of median OS. Breast carried the highest median OS (18 months) compared to gastrointestinal tumours (7 months) and metastases of unknown origin (5 months). Higher functional performance at baseline was associated with greater median OS: from KPS 100 (18 months) to KPS 70 (6 months). Lower intracranial disease burden conferred greater median OS: patients with 1-3 treated lesions survived significantly longer (11 months) than those with 4 or more (9 months)(p = 0.001). Median OS reduced with an increasing total volume of treated metastases: 13 months if <5000mm3, compared to 4 months if >30000mm3. Following SRS, 375(33.7%) patients had new brain metastases with a median time of 6 months. 13.3% of these were local recurrence, and median time to recurrence ranged from 1.5 months in renal primary to 14.3 and 17.7 months in breast and gastrointestinal tumours, respectively. 195(17.5%) patients underwent further SRS with a median time of 7 months. CONCLUSION Primary diagnosis, KPS, and intracranial disease burden are significant pre-treatment predictors of OS for SRS in brain metastases.
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